The Application

This application is for Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women.

Healthy Kids Medical Insurance is Health and Dental Insurance for children under age 19.

Medical Coverage for Pregnant Women is free health insurance for pregnant women of any age.

If your child is not currently enrolled in Healthy Kids there are three ways to apply:

1. You can request that an application be sent to your home, please click here.
2. You can download and print a blank Application for Healthy Kids.
3. You can fill out the application online and print a copy to be signed and mailed to our office in Concord. Online Application.

If you need help filling out the application there are many people who can help you.

• Call our office to get help over the phone at 1-877-464-2447
• Email apphelp@nhhealthykids.com to get help with your application or to set up an appointment for help over the phone
• Visit our office for help in person
• Click for directions
• Visit one of our application assistance sites for help in person
• Call for a list of sites in your area (1-877-464-2447)

The Application Steps:

1. Fill out the application completely and sign it on page 6
2. Review the list of proofs on page 8. Some documents may require originals instead of copies
3. Mail the application to:

   NH Healthy Kids
   1 Pillsbury Street, Suite 300
   Concord, NH 03301

If your child is currently enrolled in Healthy Kids the following application should be used for the yearly renewal of your child's health coverage, Renewal Application.  The Renewal Application is also available in Spanish.